Archive for the ‘Multiple Sclerosis’ Category

While there is no cure for multiple sclerosis yet, there are plenty of options available that can help treat symptoms, relapses, and the disease itself.

For those most part, those treatments can fall into one of three camps, each with different purposes. Those treatments are medications, corticosteroids, and disease modifying agents.

Let’s look at each a little more closely.

Medications

Medications may be used short term or long term, and for a variety of different reasons. In general, though, most doctors will prescribe medications as part of an effort to minimize the intensity of various symptoms, thereby improving daily function and quality of life. For instance, if MS is resulting in depression for you, a doctor might prescribe antidepressants.

Corticosteroids

Steroids are often prescribed for MS patients as a way of reducing the severity of a flare-up or relapse, and as such, are usually only prescribed over short periods of time, such as a few days up to a few weeks. Prednisone is one of the most commonly prescribed, though there are others as well.

Disease-Modifying Agents

So far the FDA has approved close to a dozen of these drugs, each of which is aimed at slowing the progression of multiple sclerosis. In general they are most often prescribed for patients with relapse remitting MS or secondary progressive MS.

Combination Prescriptions

For most MS patients, their treatment plan may include several different prescriptions from more than one of the categories above. Some treatments work better than others, and what works well for one MS patient may not work at all for another. As a result, it can take time to determine a medication plan that makes sense for your individual case.

Medications and steroids have long been part of MS treatment plans; disease-modifying agents are a little newer, but most MS patients are now on them.

Let’s look a little more closely.

DMA Questions

DMAs aren’t always easy to take, can have serious side effects (which means they require far more monitoring and testing than the more established other classes of MS drugs), and can be quite expensive. While some patients get assistance in paying for these drugs, either through drug trials, financial aid, or spectacular insurance, far more MS patients are forced to pay out of pocket.

And some studies are now suggesting that DMAs may not work, as interferons (the active part of DMAs) may not actually reduce MS progression. At this time, the research remains mixed.

So should you take a DMA. Or what medication should you take?

Medication Guidelines

First, keep in mind that you didn’t go to medical school. Your doctors, on the other hand, did. At the same time, it’s your body, and you have every right to be informed about what goes in it as part of your treatment plan.

Toward that end, I have a few tips:

Doctors aren’t always right. MS patients should listen to their doctor’s knowledge and expertise, certainly, but they should also have final say as to what goes in their body.

You rarely if ever will have to make a treatment decision immediately. Instead, you can take your time in doing your research most of the time, as a delay of a few weeks will rarely make a difference in the overall progression of your MS. Use common sense, but also do your research.

Toward that end, research thoroughly. Look at the drug trials information, the contraindications, and more. Carefully evaluate any study you look at.

And lastly, know the risks and benefits of any drug you do take. If you’re young especially, consider the long-term risks as well.

There still is no cure for MS, nor is there any magic that it’ll make it disappear. You can, however, manage your treatment and do your homework. You can also take care of yourself by taking your own action, making sure you get plenty of sleep, limit stress, exercise regularly, and eat well. Alternative therapies such as massage or yoga can also help.

No matter what your treatment, though, remember: You are in charge of your MS.

Multiple sclerosis (MS) is a chronic, often disabling disease that attacks the central nervous system (brain and spinal cord). The exact cause of MS is unknown, and at this time there is no cure. Many advances in research and treatments are giving hope to people who are affected by the disease.

TheNational Multiple Sclerosis Societyestimates that more than 400,000 people in North America are living with MS. In Michigan, more than 15,000 people are diagnosed with the disease. Most people with MS are diagnosed between the ages of 20 and 40, but the unpredictable physical and emotional effects last a lifetime.

The progression and specific symptoms of MS in an individual cannot be predicted. They vary depending on the extent and severity of the disease and the location of lesions within the brain and spinal cord. Some of the most common symptoms are:

While the progression, severity and specific symptoms of MS vary by patient,MS is divided into four distinct classifications.

If your doctor suspects you have multiple sclerosis, he or she may refer you toMidMichigan's MS Clinic, which is affiliated with the National Multiple Sclerosis Society.

Because there is no known cause for MS, it is often difficult to diagnosis. Several tests are necessary for confirmation, including:

Because there is no known cause and as yet no cure, a multidisciplinary approach is the most beneficial in preventing progression of MS. This approach consists of medications, exercise, stress management, relaxation, adequate nutrition and an overall healthy lifestyle. Again, MidMichigan's MS Clinic is available to help with many of these services.

Many medications can help manage the symptoms of MS. Your neurologist will choose the right medication for you based on the results of diagnostic testing and clinical examination. Treatments may include:

It is important to become familiar with your symptoms in order to recognize flare-ups and seek appropriate and timely intervention.

AVONEX is a registered trademark of Biogen

BETASERON is a registered trademark of Berlex Laboratories, Inc.

COPAXONE is a registered trademark of Teva Pharmaceutical Industries, Ltd.

REBIF is a registered trademark of Serono S. A.

EXTAVIA is a registered trademark of Novartis Pharmaceuticals Corporation

If you have MS, your doctor may recommendrehabilitation therapy in addition to other treatment options. Rehabilitation therapy can help you and your caregiver better adapt to the changing realities of the disease and help you maintain as much independence as possible.

Multiple Sclerosis can be a challenging disease to diagnose and treat, especially when having MS can also mean having other health issues that need to be treated. The Multiple Sclerosis Center, part of the University of Michigans Department of Neurology, has highly skilled specialists with the experience to handle the most complex multiple sclerosis cases. And our team of physicians from a variety of disciplines works together to manage all your symptoms with the goal to provide a better quality of life.

Multiple sclerosis is a disease that affects the central nervous system: the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling and thinking. MS is different for each person. You may go through life with only minor problems. Or you may become seriously disabled. Most people are somewhere in between.

Our Multiple Sclerosis Center is accredited as a Center for Excellence by the National Multiple Sclerosis Society. Working closely with a multidisciplinary team of experts, we effectively treat all issues that can play a part in multiple sclerosis, including:

Confirming diagnosis is so crucial, and yet weve seen so many patients who have been misdiagnosed. We are experts in diagnosing multiple sclerosis, as well as recognized what is not MS. We offer cutting-edge MRI imaging, which is our primary window into the brain and spine. We also run the full repertoire of lab tests to exclude other possibilities before coming to a conclusion. And, because multiple sclerosis can continue to progress with the absence of symptoms, we conduct periodic exams and MRIs.

There is no cure for multiple sclerosis, so our goal is to hold your disease in check. Its not a one-size-fits-all solution and there are many potential treatments available. It takes experience to not only be familiar with all the therapies along with the benefits, risks and side effects of each but to also understand which treatment is best for each patient. We also educate you so you know what to expect and how to best take care of yourself. Treatment ranges from oral medication and self-injecting therapy to chemotherapy treatments and infusions.

Since many MS medications are only available at an infusion center, we spearheaded the development of our new onsite, 10-bed East Ann Arbor Infusion Center. Specially trained nurses, who administer steroids, other medications and chemotherapies, staff the Center.

Designated a Multiple Sclerosis Collaborative Research Center by the National Multiple Sclerosis Society, we are actively involved in research to increase the understanding of the underlying causes of multiple sclerosis, and to gain insight into the development of new treatment approaches. And, we participate in clinical trials to evaluate the next generation of MS therapeutics.

Multiple sclerosis (MS), also known as disseminated sclerosis or encephalomyelitis disseminata, is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms,[1][2] including physical, mental,[2] and sometimes psychiatric problems.[3] MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms).[4] Between attacks, symptoms may disappear completely; however, permanent neurological problems often occur, especially as the disease advances.[4]

While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells.[5] Proposed causes for this include genetics and environmental factors such as infections.[2][6] MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests.

There is no known cure for multiple sclerosis. Treatments attempt to improve function after an attack and prevent new attacks.[2] Medications used to treat MS while modestly effective can have adverse effects and be poorly tolerated. Many people pursue alternative treatments, despite a lack of evidence. The long-term outcome is difficult to predict, with good outcomes more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks.[7]Life expectancy is on average 5 to 10 years lower than that of an unaffected population.[1]

Multiple sclerosis is the most common autoimmune disorder affecting the central nervous system.[8] As of 2008, between 2 and 2.5 million people are affected globally with rates varying widely in different regions of the world and among different populations.[9] In 2013, 20,000 people died from MS, up from 12,000 in 1990.[10] The disease usually begins between the ages of 20 and 50 and is twice as common in women as in men.[11] The name multiple sclerosis refers to scars (scleraebetter known as plaques or lesions) in particular in the white matter of the brain and spinal cord.[12] MS was first described in 1868 by Jean-Martin Charcot.[12] A number of new treatments and diagnostic methods are under development.

A person with MS can have almost any neurological symptom or sign; with autonomic, visual, motor, and sensory problems being the most common.[1] The specific symptoms are determined by the locations of the lesions within the nervous system, and may include loss of sensitivity or changes in sensation such as tingling, pins and needles or numbness, muscle weakness, very pronounced reflexes, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems with speech or swallowing, visual problems (nystagmus, optic neuritis or double vision), feeling tired, acute or chronic pain, and bladder and bowel difficulties, among others.[1] Difficulties thinking and emotional problems such as depression or unstable mood are also common.[1]Uhthoff's phenomenon, a worsening of symptoms due to exposure to higher than usual temperatures, and Lhermitte's sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS.[1] The main measure of disability and severity is the expanded disability status scale (EDSS), with other measures such as the multiple sclerosis functional composite being increasingly used in research.[13][14][15]

The condition begins in 85% of cases as a clinically isolated syndrome over a number of days with 45% having motor or sensory problems, 20% having optic neuritis, and 10% having symptoms related to brainstem dysfunction, while the remaining 25% have more than one of the previous difficulties.[16] The course of symptoms occurs in two main patterns initially: either as episodes of sudden worsening that last a few days to months (called relapses, exacerbations, bouts, attacks, or flare-ups) followed by improvement (85% of cases) or as a gradual worsening over time without periods of recovery (10-15% of cases).[11] A combination of these two patterns may also occur[4] or people may start in a relapsing and remitting course that then becomes progressive later on.[11] Relapses are usually not predictable, occurring without warning.[1] Exacerbations rarely occur more frequently than twice per year.[1] Some relapses, however, are preceded by common triggers and they occur more frequently during spring and summer.[17] Similarly, viral infections such as the common cold, influenza, or gastroenteritis increase their risk.[1]Stress may also trigger an attack.[18] Women with MS who become pregnant experience fewer relapses; however, during the first months after delivery the risk increases.[1] Overall, pregnancy does not seem to influence long-term disability.[1] Many events have not been found to affect relapse rates including vaccination, breast feeding,[1] physical trauma,[19] and Uhthoff's phenomenon.[17]

The cause of MS is unknown; however, it is believed to occur as a result of some combination of genetic and environmental factors such as infectious agents.[1] Theories try to combine the data into likely explanations, but none has proved definitive. While there are a number of environmental risk factors and although some are partly modifiable, further research is needed to determine whether their elimination can prevent MS.[20]

MS is more common in people who live farther from the equator, although exceptions exist.[1][21] These exceptions include ethnic groups that are at low risk far from the equator such as the Samis, Amerindians, Canadian Hutterites, New Zealand Mori,[22] and Canada's Inuit,[11] as well as groups that have a relatively high risk close to the equator such as Sardinians,[11] inland Sicilians,[23]Palestinians and Parsis.[22] The cause of this geographical pattern is not clear.[11] While the north-south gradient of incidence is decreasing,[21] as of 2010 it is still present.[11]

MS is more common in regions with northern European populations[1] and the geographic variation may simply reflect the global distribution of these high-risk populations.[11] Decreased sunlight exposure resulting in decreased vitamin D production has also been put forward as an explanation.[24][25][26] A relationship between season of birth and MS lends support to this idea, with fewer people born in the northern hemisphere in November as compared to May being affected later in life.[27] Environmental factors may play a role during childhood, with several studies finding that people who move to a different region of the world before the age of 15 acquire the new region's risk to MS. If migration takes place after age 15, however, the person retains the risk of his home country.[1][20] There is some evidence that the effect of moving may still apply to people older than 15.[1]

MS is not considered a hereditary disease; however, a number of genetic variations have been shown to increase the risk.[28] The probability is higher in relatives of an affected person, with a greater risk among those more closely related.[2] In identical twins both are affected about 30% of the time, while around 5% for non-identical twins and 2.5% of siblings are affected with a lower percentage of half-siblings.[1][2][29] If both parents are affected the risk in their children is 10 times that of the general population.[11] MS is also more common in some ethnic groups than others.[30]

Specific genes that have been linked with MS include differences in the human leukocyte antigen (HLA) systema group of genes on chromosome 6 that serves as the major histocompatibility complex (MHC).[1] That changes in the HLA region are related to susceptibility has been known since the 1980s,[31] and additionally this same region has been implicated in the development of other autoimmune diseases such as diabetes type I and systemic lupus erythematosus.[31] The most consistent finding is the association between multiple sclerosis and alleles of the MHC defined as DR15 and DQ6.[1] Other loci have shown a protective effect, such as HLA-C554 and HLA-DRB1*11.[1] Overall, it has been estimated that HLA changes account for between 20 and 60% of the genetic predisposition.[31] Modern genetic methods (genome-wide association studies) have discovered at least twelve other genes outside the HLA locus that modestly increase the probability of MS.[31]

Many microbes have been proposed as triggers of MS, but none have been confirmed.[2] Moving at an early age from one location in the world to another alters a person's subsequent risk of MS.[6] An explanation for this could be that some kind of infection, produced by a widespread microbe rather than a rare one, is related to the disease.[6] Proposed mechanisms include the hygiene hypothesis and the prevalence hypothesis. The hygiene hypothesis proposes that exposure to certain infectious agents early in life is protective, the disease being a response to a late encounter with such agents.[1] The prevalence hypothesis proposes that the disease is due to an infectious agent more common in regions where MS is common and where in most individuals it causes an ongoing infection without symptoms. Only in a few cases and after many years does it cause demyelination.[6][32] The hygiene hypothesis has received more support than the prevalence hypothesis.[6]

Evidence for a virus as a cause include: the presence of oligoclonal bands in the brain and cerebrospinal fluid of most people with MS, the association of several viruses with human demyelination encephalomyelitis, and the occurrence of demyelination in animals caused by some viral infection.[33]Human herpes viruses are a candidate group of viruses. Individuals having never been infected by the Epstein-Barr virus are at a reduced risk of getting MS, whereas those infected as young adults are at a greater risk than those having had it at a younger age.[1][6] Although some consider that this goes against the hygiene hypothesis, since the non-infected have probably experienced a more hygienic upbringing,[6] others believe that there is no contradiction, since it is a first encounter with the causative virus relatively late in life that is the trigger for the disease.[1] Other diseases that may be related include measles, mumps and rubella.[1]

Smoking has been shown to be an independent risk factor for MS.[24]Stress may be a risk factor although the evidence to support this is weak.[20] Association with occupational exposures and toxinsmainly solventshas been evaluated, but no clear conclusions have been reached.[20]Vaccinations were studied as causal factors; however, most studies show no association.[20] Several other possible risk factors, such as diet and hormone intake, have been looked at; however, evidence on their relation with the disease is "sparse and unpersuasive".[24]Gout occurs less than would be expected and lower levels of uric acid have been found in people with MS. This has led to the theory that uric acid is protective, although its exact importance remains unknown.[34]

The three main characteristics of MS are the formation of lesions in the central nervous system (also called plaques), inflammation, and the destruction of myelin sheaths of neurons. These features interact in a complex and not yet fully understood manner to produce the breakdown of nerve tissue and in turn the signs and symptoms of the disease.[1] Additionally, MS is believed to be an immune-mediated disorder that develops from an interaction of the individual's genetics and as yet unidentified environmental causes.[2] Damage is believed to be caused, at least in part, by attack on the nervous system by a person's own immune system.[1]

The name multiple sclerosis refers to the scars (sclerae better known as plaques or lesions) that form in the nervous system. These lesions most commonly affect the white matter in the optic nerve, brain stem, basal ganglia, and spinal cord, or white matter tracts close to the lateral ventricles.[1] The function of white matter cells is to carry signals between grey matter areas, where the processing is done, and the rest of the body. The peripheral nervous system is rarely involved.[2]

To be specific, MS involves the loss of oligodendrocytes, the cells responsible for creating and maintaining a fatty layerknown as the myelin sheathwhich helps the neurons carry electrical signals (action potentials).[1] This results in a thinning or complete loss of myelin and, as the disease advances, the breakdown of the axons of neurons. When the myelin is lost, a neuron can no longer effectively conduct electrical signals.[2] A repair process, called remyelination, takes place in early phases of the disease, but the oligodendrocytes are unable to completely rebuild the cell's myelin sheath.[35] Repeated attacks lead to successively less effective remyelinations, until a scar-like plaque is built up around the damaged axons.[35] These scars are the origin of the symptoms and during an attack magnetic resonance imaging (MRI) often shows more than ten new plaques.[1] This could indicate that there are a number of lesions below which the brain is capable of repairing itself without producing noticeable consequences.[1] Another process involved in the creation of lesions is an abnormal increase in the number of astrocytes due to the destruction of nearby neurons.[1] A number of lesion patterns have been described.[36]

Apart from demyelination, the other sign of the disease is inflammation. Fitting with an immunological explanation, the inflammatory process is caused by T cells, a kind of lymphocyte that plays an important role in the body's defenses.[2] T cells gain entry into the brain via disruptions in the bloodbrain barrier. The T cells recognize myelin as foreign and attack it, explaining why these cells are also called "autoreactive lymphocytes".[1]

The attack of myelin starts inflammatory processes, which triggers other immune cells and the release of soluble factors like cytokines and antibodies. Further breakdown of the bloodbrain barrier, in turn cause a number of other damaging effects such as swelling, activation of macrophages, and more activation of cytokines and other destructive proteins.[2] Inflammation can potentially reduce transmission of information between neurons in at least three ways.[1] The soluble factors released might stop neurotransmission by intact neurons. These factors could lead to or enhance the loss of myelin, or they may cause the axon to break down completely.[1]

The bloodbrain barrier is a part of the capillary system that prevents the entry of T cells into the central nervous system. It may become permeable to these types of cells secondary to an infection by a virus or bacteria. After it repairs itself, typically once the infection has cleared, T cells may remain trapped inside the brain.[2]Gadolinium cannot cross a normal BBB and, therefore, Gadolinium-enhanced MRI is used to show BBB breakdowns.[37]

Multiple sclerosis is typically diagnosed based on the presenting signs and symptoms, in combination with supporting medical imaging and laboratory testing.[16] It can be difficult to confirm, especially early on, since the signs and symptoms may be similar to those of other medical problems.[1][38] The McDonald criteria, which focus on clinical, laboratory, and radiologic evidence of lesions at different times and in different areas, is the most commonly used method of diagnosis[9] with the Schumacher and Poser criteria being of mostly historical significance.[39] While the above criteria allow for a non-invasive diagnosis, some state that the only definitive proof is an autopsy or biopsy where lesions typical of MS are detected.[1][40][41]

Clinical data alone may be sufficient for a diagnosis of MS if an individual has had separate episodes of neurologic symptoms characteristic of the disease.[40] In those who seek medical attention after only one attack, other testing is needed for the diagnosis. The most commonly used diagnostic tools are neuroimaging, analysis of cerebrospinal fluid and evoked potentials. Magnetic resonance imaging of the brain and spine may show areas of demyelination (lesions or plaques). Gadolinium can be administered intravenously as a contrast agent to highlight active plaques and, by elimination, demonstrate the existence of historical lesions not associated with symptoms at the moment of the evaluation.[40][42] Testing of cerebrospinal fluid obtained from a lumbar puncture can provide evidence of chronic inflammation in the central nervous system. The cerebrospinal fluid is tested for oligoclonal bands of IgG on electrophoresis, which are inflammation markers found in 7585% of people with MS.[40][43] The nervous system in MS may respond less actively to stimulation of the optic nerve and sensory nerves due to demyelination of such pathways. These brain responses can be examined using visual- and sensory-evoked potentials.[44]

Several phenotypes (commonly named types), or patterns of progression, have been described. Phenotypes use the past course of the disease in an attempt to predict the future course. They are important not only for prognosis but also for treatment decisions. In 1996, the United States National Multiple Sclerosis Society described four clinical courses.[4] This set of courses was later reviewed by an international panel in 2013, adding clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) as phenotypes, but leaving the main structure untouched.[45]

The relapsing-remitting subtype is characterized by unpredictable relapses followed by periods of months to years of relative quiet (remission) with no new signs of disease activity. Deficits that occur during attacks may either resolve or leave problems, the latter in about 40% of attacks and being more common the longer a person has had the disease.[1][16] This describes the initial course of 80% of individuals with MS.[1] When deficits always resolve between attacks, this is sometimes referred to as benign MS,[46] although people will still build up some degree of disability in the long term.[1] On the other hand, the term malignant multiple sclerosis is used to describe people with MS having reached significant level of disability in a short period.[47] The relapsing-remitting subtype usually begins with a clinically isolated syndrome (CIS). In CIS, a person has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis.[1][48] 30 to 70% of persons experiencing CIS later develop MS.[48]

Secondary progressive MS occurs in around 65% of those with initial relapsing-remitting MS, who eventually have progressive neurologic decline between acute attacks without any definite periods of remission.[1][4] Occasional relapses and minor remissions may appear.[4] The most common length of time between disease onset and conversion from relapsing-remitting to secondary progressive MS is 19years.[49]

The primary progressive subtype occurs in approximately 1020% of individuals, with no remission after the initial symptoms.[16][50] It is characterized by progression of disability from onset, with no, or only occasional and minor, remissions and improvements.[4] The usual age of onset for the primary progressive subtype is later than of the relapsing-remitting subtype. It is similar to the age that secondary progressive usually begins in relapsing-remitting MS, around 40 years of age.[1]

Progressive relapsing MS describes those individuals who, from onset, have a steady neurologic decline but also have clear superimposed attacks. This is the least common of all subtypes.[4]

Unusual types of MS have been described; these include Devic's disease, Balo concentric sclerosis, Schilder's diffuse sclerosis, and Marburg multiple sclerosis. There is debate on whether they are MS variants or different diseases.[51] Multiple sclerosis behaves differently in children, taking more time to reach the progressive stage.[1] Nevertheless, they still reach it at a lower average age than adults usually do.[1]

Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects. Alternative treatments are pursued by some people, despite the shortage of supporting evidence.

During symptomatic attacks, administration of high doses of intravenous corticosteroids, such as methylprednisolone, is the usual therapy,[1] with oral corticosteroids seeming to have a similar efficacy and safety profile.[52] Although, in general, effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.[53] The consequences of severe attacks that do not respond to corticosteroids might be treatable by plasmapheresis.[1]

In RRMS they are modestly effective at decreasing the number of attacks.[54] The interferons and glatiramer acetate are first-line treatments[16] and are roughly equivalent, reducing relapses by approximately 30%.[59] Early-initiated long-term therapy is safe and improves outcomes.[60][61] Natalizumab reduces the relapse rate more than first-line agents; however, due to issues of adverse effects is a second-line agent reserved for those who do not respond to other treatments[16] or with severe disease.[59] Mitoxantrone, whose use is limited by severe adverse effects, is a third-line option for those who do not respond to other medications.[16] Treatment of clinically isolated syndrome (CIS) with interferons decreases the chance of progressing to clinical MS.[1][62] Efficacy of interferons and glatiramer acetate in children has been estimated to be roughly equivalent to that of adults.[63] The role of some newer agents such as fingolimod, teriflunomide, and dimethyl fumarate, as of 2011, is not yet entirely clear.[64]

No treatment has been shown to change the course of primary progressive MS[16] and as of 2011 only one medication, mitoxantrone, has been approved for secondary progressive MS.[65] In this population tentative evidence supports mitoxantrone moderately slowing the progression of the disease and decreasing rates of relapses over two years.[66][67]

The disease-modifying treatments have several adverse effects. One of the most common is irritation at the injection site for glatiramer acetate and the interferons (up to 90% with subcutaneous injections and 33% with intramuscular injections).[68] Over time, a visible dent at the injection site, due to the local destruction of fat tissue, known as lipoatrophy, may develop.[68] Interferons may produce flu-like symptoms;[69] some people taking glatiramer experience a post-injection reaction with flushing, chest tightness, heart palpitations, and anxiety, which usually lasts less than thirty minutes.[70] More dangerous but much less common are liver damage from interferons,[71]systolic dysfunction (12%), infertility, and acute myeloid leukemia (0.8%) from mitoxantrone,[66][72] and progressive multifocal leukoencephalopathy occurring with natalizumab (occurring in 1 in 600 people treated).[16][73]

Fingolimod may give rise to hypertension and slowed heart rate, macular edema, elevated liver enzymes or a reduction in lymphocyte levels.[64] Tentative evidence supports the short-term safety of teriflunomide, with common side effects including: headaches, fatigue, nausea, hair loss, and limb pain.[54] There have also been reports of liver failure and PML with its use and it is dangerous for fetal development.[64] Most common side effects of dimethyl fumarate are flushing and gastrointestinal problems.[56][64] While dimethyl fumarate may lead to a reduction in the white blood cell count there were no reported cases of opportunistic infections during trials.[74][75]

Both medications and neurorehabilitation have been shown to improve some symptoms, though neither changes the course of the disease.[76] Some symptoms have a good response to medication, such as an unstable bladder and spasticity, while others are little changed.[1] For neurologic problems, a multidisciplinary approach is important for improving quality of life; however, it is difficult to specify a 'core team' as many health services may be needed at different points in time.[1] Multidisciplinary rehabilitation programs increase activity and participation of people with MS but do not influence impairment level.[77] There is limited evidence for the overall efficacy of individual therapeutic disciplines,[78][79] though there is good evidence that specific approaches, such as exercise,[80][81] and psychology therapies, in particular cognitive behavioral approaches are effective.[82]

Over 50% of people with MS may use complementary and alternative medicine, although percentages vary depending on how alternative medicine is defined.[83] The evidence for the effectiveness for such treatments in most cases is weak or absent.[83][84] Treatments of unproven benefit used by people with MS include: dietary supplementation and regimens,[83][85][86] vitamin D,[87]relaxation techniques such as yoga,[83]herbal medicine (including medical cannabis),[83][88]hyperbaric oxygen therapy,[89]self-infection with hookworms, reflexology and acupuncture.[83][90] Regarding the characteristics of users, they are more frequently women, have had MS for a longer time, tend to be more disabled and have lower levels of satisfaction with conventional healthcare.[83]

no data

<13

1316

1619

1922

2225

2528

2831

3134

3437

3740

4043

>43

The expected future course of the disease depends on the subtype of the disease; the individual's sex, age, and initial symptoms; and the degree of disability the person has.[7] Female sex, relapsing-remitting subtype, optic neuritis or sensory symptoms at onset, few attacks in the initial years and especially early age at onset, are associated with a better course.[7][91]

The average life expectancy is 30 years from the start of the disease, which is 5 to 10 years less than that of unaffected people.[1] Almost 40% of people with MS reach the seventh decade of life.[91] Nevertheless, two-thirds of the deaths are directly related to the consequences of the disease.[1]Suicide is more common, while infections and other complications are especially dangerous for the more disabled.[1] Although most people lose the ability to walk before death, 90% are capable of independent walking at 10 years from onset, and 75% at 15 years.[91][92]

MS is the most common autoimmune disorder of the central nervous system.[8] As of 2010, the number of people with MS was 22.5million (approximately 30 per 100,000) globally, with rates varying widely in different regions.[9][11] It is estimated to have resulted in 18,000 deaths that year.[93] In Africa rates are less than 0.5 per 100,000, while they are 2.8 per 100,000 in South East Asia, 8.3 per 100,000 in the Americas, and 80 per 100,000 in Europe.[9] Rates surpass 200 per 100,000 in certain populations of Northern European descent.[11] The number of new cases that develop per year is about 2.5 per 100,000.[9]

Rates of MS appear to be increasing; this, however, may be explained simply by better diagnosis.[11] Studies on populational and geographical patterns have been common[32] and have led to a number of theories about the cause.[6][20][24]

MS usually appears in adults in their late twenties or early thirties but it can rarely start in childhood and after 50 years of age.[9][11] The primary progressive subtype is more common in people in their fifties.[50] Similar to many autoimmune disorders, the disease is more common in women, and the trend may be increasing.[1][21] As of 2008, globally it is about two times more common in women than in men.[9] In children, it is even more common in females than males,[1] while in people over fifty, it affects males and females almost equally.[50]

The French neurologist Jean-Martin Charcot (18251893) was the first person to recognize multiple sclerosis as a distinct disease in 1868.[94] Summarizing previous reports and adding his own clinical and pathological observations, Charcot called the disease sclerose en plaques. The three signs of MS now known as Charcot's triad 1 are nystagmus, intention tremor, and telegraphic speech (scanning speech), though these are not unique to MS. Charcot also observed cognition changes, describing his patients as having a "marked enfeeblement of the memory" and "conceptions that formed slowly".[12]

Before Charcot, Robert Carswell (17931857), a British professor of pathology, and Jean Cruveilhier (17911873), a French professor of pathologic anatomy, had described and illustrated many of the disease's clinical details, but did not identify it as a separate disease.[94] Specifically, Carswell described the injuries he found as "a remarkable lesion of the spinal cord accompanied with atrophy".[1] Under the microscope, Swiss pathologist Georg Eduard Rindfleisch (18361908) noted in 1863 that the inflammation-associated lesions were distributed around blood vessels.[95][96] During the 20th century theories about the cause and pathogenesis were developed and effective treatments began to appear in the 1990s.[1]

There are several historical accounts of people who probably had MS and lived before or shortly after the disease was described by Charcot.

A young woman called Halldora who lived in Iceland around 1200 suddenly lost her vision and mobility but, after praying to the saints, recovered them seven days after. Saint Lidwina of Schiedam (13801433), a Dutch nun, may be one of the first clearly identifiable people with MS. From the age of 16 until her death at 53, she had intermittent pain, weakness of the legs, and vision losssymptoms typical of MS.[97] Both cases have led to the proposal of a "Viking gene" hypothesis for the dissemination of the disease.[98]

Augustus Frederick d'Este (17941848), son of Prince Augustus Frederick, Duke of Sussex and Lady Augusta Murray and the grandson of GeorgeIII of the United Kingdom, almost certainly had MS. D'Este left a detailed diary describing his 22 years living with the disease. His diary began in 1822 and ended in 1846, although it remained unknown until 1948. His symptoms began at age 28 with a sudden transient visual loss (amaurosis fugax) after the funeral of a friend. During his disease, he developed weakness of the legs, clumsiness of the hands, numbness, dizziness, bladder disturbances, and erectile dysfunction. In 1844, he began to use a wheelchair. Despite his illness, he kept an optimistic view of life.[99][100] Another early account of MS was kept by the British diarist W. N. P. Barbellion, nom-de-plume of Bruce Frederick Cummings (18891919), who maintained a detailed log of his diagnosis and struggle.[100] His diary was published in 1919 as The Journal of a Disappointed Man.[101]

There is ongoing research looking for more effective, convenient, and tolerable treatments for relapsing-remitting MS; creation of therapies for the progressive subtypes; neuroprotection strategies; and effective symptomatic treatments.[102]

During the 2000s and 2010s, there has been approval of several oral drugs that are expected to gain in popularity and frequency of use.[103] Several more oral drugs are under investigation, one being laquinimod, which was announced in August 2012 and is in a third phase III trial after mixed results in the previous ones.[104] Similarly, studies aimed to improve the efficacy and ease of use of already existing therapies are occurring. This includes the use of new preparations such as the PEGylated version of interferon--1a, which it is hoped may be given at less frequent doses with similar effects.[105][106] Request for approval of peginterferon beta-1a is expected during 2013.[106]

Monoclonal antibodies have also raised high levels of interest. Alemtuzumab, daclizumab, and CD20 monoclonal antibodies such as rituximab, ocrelizumab and ofatumumab have all shown some benefit and are under study as potential treatments.[75] Their use has also been accompanied by the appearance of potentially dangerous adverse effects, the most important of which being opportunistic infections.[103] Related to these investigations is the development of a test for JC virus antibodies, which might help to determine who is at greater risk of developing progressive multifocal leukoencephalopathy when taking natalizumab.[103] While monoclonal antibodies will probably have some role in the treatment of the disease in the future, it is believed that it will be small due to the risks associated with them.[103]

Another research strategy is to evaluate the combined effectiveness of two or more drugs.[107] The main rationale for using a number of medications in MS is that the involved treatments target different mechanisms and, therefore, their use is not necessarily exclusive.[107]Synergies, in which one drug improves the effect of another are also possible, but there can also be drawbacks such as the blocking of the action of the other or worsened side-effects.[107] There have been several trials of combined therapy, yet none have shown positive enough results to be considered as a useful treatment for MS.[107]

Research on neuroprotection and regenerative treatments, such as stem cell therapy, while of high importance, are in the early stages.[108] Likewise, there are not any effective treatments for the progressive variants of the disease. Many of the newest drugs as well as those under development are probably going to be evaluated as therapies for PPMS or SPMS.[103]

While diagnostic criteria are not expected to change in the near future, work to develop biomarkers that help with diagnosis and prediction of disease progression is ongoing.[103] New diagnostic methods that are being investigated include work with anti-myelin antibodies, and studies with serum and cerebrospinal fluid, but none of them has yielded reliably positive results.[110]

At the current time, there are no laboratory investigations that can predict prognosis. Several promising approaches have been proposed including: interleukin-6, nitric oxide and nitric oxide synthase, osteopontin, and fetuin-A.[110] Since disease progression is the result of degeneration of neurons, the roles of proteins showing loss of nerve tissue such as neurofilaments, tau, and N-acetylaspartate are under investigation.[110] Other effects include looking for biomarkers that distinguish between those who will and will not respond to medications.[110]

Improvement in neuroimaging techniques such as positron emission tomography (PET) or magnetic resonance imaging (MRI) carry a promise for better diagnosis and prognosis predictions, although the effect of such improvements in daily medical practice may take several decades.[103] Regarding MRI, there are several techniques that have already shown some usefulness in research settings and could be introduced into clinical practice, such as double-inversion recovery sequences, magnetization transfer, diffusion tensor, and functional magnetic resonance imaging.[111] These techniques are more specific for the disease than existing ones, but still lack some standardization of acquisition protocols and the creation of normative values.[111] There are other techniques under development that include contrast agents capable of measuring levels of peripheral macrophages, inflammation, or neuronal dysfunction,[111] and techniques that measure iron deposition that could serve to determine the role of this feature in MS, or that of cerebral perfusion.[111] Similarly, new PET radiotracers might serve as markers of altered processes such as brain inflammation, cortical pathology, apoptosis, or remylienation.[112] Antibiodies against the Kir4.1 potassium channel may be related to MS.[113]

In 2008, vascular surgeon Paolo Zamboni suggested that MS involves narrowing of the veins draining the brain, which he referred to as chronic cerebrospinal venous insufficiency (CCSVI). He found CCSVI in all patients with MS in his study, performed a surgical procedure, later called in the media the "liberation procedure" to correct it, and claimed that 73% of participants improved.[114] This theory received significant attention in the media and among those with MS, especially in Canada.[115] Concerns have been raised with Zamboni's research as it was neither blinded nor controlled, and its assumptions about the underlying cause of the disease is not backed by known data.[116] Also, further studies have either not found a similar relationship or found one that is much less strong one,[117] raising serious objections to the hypothesis.[118] The "liberation procedure" has been criticized for resulting in serious complications and deaths with unproven benefits.[116] It is, thus, as of 2013 not recommended for the treatment of MS.[119] Additional research investigating the CCSVI hypothesis are under way.[120]

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Multiple sclerosis can cause a variety of symptoms: changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty moving; difficulties with coordination and balance; problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, phosphenes or diplopia), fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or emotional symptomatology (mainly major depression). The main clinical measure in progression of the disability and severity of the symptoms is the Expanded Disability Status Scale or EDSS.[1]

The initial attacks are often transient, mild (or asymptomatic), and self-limited. They often do not prompt a health care visit and sometimes are only identified in retrospect once the diagnosis has been made after further attacks. The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (20%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%); but many rare initial symptoms have been reported such as aphasia or psychosis.[2][3] Fifteen percent of individuals have multiple symptoms when they first seek medical attention.[4]

Bladder problems (See also urinary system and urination) appear in 7080% of people with multiple sclerosis (MS) and they have an important effect both on hygiene habits and social activity.[5][6] Bladder problems are usually related with high levels of disability and pyramidal signs in lower limbs.[7]

The most common problems are an increase in frequency and urgency (incontinence) but difficulties to begin urination, hesitation, leaking, sensation of incomplete urination, and retention also appear. When retention occurs secondary urinary infections are common.

There are many cortical and subcortical structures implicated in urination[8] and MS lesions in various central nervous system structures can cause these kinds of symptoms.

Treatment objectives are the alleviation of symptoms of urinary dysfunction, treatment of urinary infections, reduction of complicating factors and the preservation of renal function. Treatments can be classified in two main subtypes: pharmacological and non-pharmacological. Pharmacological treatments vary greatly depending on the origin or type of dysfunction and some examples of the medications used are:[9]alfuzosin for retention,[10]trospium and flavoxate for urgency and incontinency,[11][12] and desmopressin for nocturia.[13][14] Non pharmacological treatments involve the use of pelvic floor muscle training, stimulation, biofeedback, pessaries, bladder retraining, and sometimes intermittent catheterization.[15][16]

Bowel problems affect around 70% of the patients, with around 50% of the patients suffering from constipation and up to 30% from fecal incontinence.[16] Cause of bowel impairments in MS patients is usually either a reduced gut motility or an impairment in neurological control of defecation. The former is commonly related to immobility or secondary effects from drugs used in the treatment of the disease.[16] Pain or problems with defecation can be helped with a diet change which includes among other changes an increased fluid intake, oral laxatives or suppositories and enemas when habit changes and oral measures are not enough to control the problems.[16][17]

Some of the most common deficits affect recent memory, attention, processing speed, visual-spatial abilities and executive function.[18] Symptoms related to cognition include emotional instability and fatigue including neurological fatigue. Commonly a form of cognitive disarray is experienced, where specific cognitive processes may remain unaffected, but cognitive processes as a whole are impaired. Cognitive deficits are independent of physical disability and can occur in the absence of neurological dysfunction.[19] Severe impairment is a major predictor of a low quality of life, unemployment, caregiver distress,[20] and difficulty in driving;[21] limitations in a patient's social and work activities are also correlated with the extent of impairment.[19]

Cognitive impairments occur in about 40 to 60 percent of patients with multiple sclerosis,[22] with the lowest percentages usually from community-based studies and the highest ones from hospital-based. Impairments may present at the beginning of the disease.[23] Probable multiple sclerosis sufferers, meaning after a first attack but before a secondary confirmatory one, have up to 50 percent of patients with impairment at onset.[24]Dementia is rare and occurs in only five percent of patients.[19]

Measures of tissue atrophy are well correlated with, and predict, cognitive dysfunction. Neuropsychological outcomes are highly correlated with linear measures of sub-cortical atrophy. Cognitive impairment is the result of not only tissue damage, but tissue repair and adaptive functional reorganization.[20]Neuropsychological testing is important for determining the extent of cognitive deficits. Neuropsychological rehabilitation may help to reverse or decrease the cognitive deficits although studies on the issue have been of low quality.[25]Acetylcholinesterase inhibitors are commonly used to treat Alzheimer's disease related dementia and so are thought to have potential in treating the cognitive deficits in multiple sclerosis. They have been found to be effective in preliminary clinical trials.[25]

Emotional symptoms are also common and are thought to be both a normal response to having a debilitating disease and the result of damage to specific areas of the central nervous system that generate and control emotions.

Clinical depression is the most common neuropsychiatric condition: lifetime depression prevalence rates of 4050% and 12-month prevalence rates around 20% have been typically reported for samples of people with MS; these figures are considerably higher than those for the general population or for people with other chronic illnesses.[26][27] Brain imaging studies have tried to relate depression to lesions in certain regions of the brain have met with variable success. On balance the evidence seems to favour an association with neuropathology in the left anterior temporal/parietal regions.[28]

Other feelings such as anger, anxiety, frustration, and hopelessness also appear frequently and suicide is a very real threat since it results in 15% of deaths in MS sufferers.[29]

Rarely psychosis may also be featured.[30]

Fatigue is very common and disabling in MS with a close relationship to depressive symptomatology.[31] When depression is reduced fatigue also tends to reduce and it is recommended that patients should be evaluated for depression before other therapeutic approaches are used.[32] In a similar way other factors such as disturbed sleep, chronic pain, poor nutrition, or even some medications can all contribute to fatigue and medical professionals are encouraged to identify and modify them.[33] There are also different medications used to treat fatigue; such as amantadine,[34][35] or pemoline;[36][37] as well as psychological interventions of energy conservation;[38][39] but their effects are small[citation needed] and for these reasons fatigue is a difficult symptom to manage. Fatigue has also been related to specific brain areas in MS using magnetic resonance imaging.[40]

Internuclear ophthalmoplegia is a disorder of conjugate lateral gaze. The affected eye shows impairment of adduction. The partner eye diverges from the affected eye during abduction, producing diplopia; during extreme abduction, compensatory nystagmus can be seen in the partner eye. Diplopia means double vision while nystagmus is involuntary eye movement characterized by alternating smooth pursuit in one direction and a saccadic movement in the other direction.

Internuclear ophthalmoplegia occurs when MS affects a part of the brain stem called the medial longitudinal fasciculus, which is responsible for communication between the two eyes by connecting the abducens nucleus of one side to the oculomotor nucleus of the opposite side. This results in the failure of the medial rectus muscle to contract appropriately, so that the eyes do not move equally (called disconjugate gaze).

Different drugs as well as optic compensatory systems and prisms can be used to improve these symptoms.[41][42][43][44] Surgery can also be used in some cases for this problem.[45]

Restrictions in mobility (walking, transfers, bed mobility etc.) are common in individuals suffering from multiple sclerosis. Within 10 years after the onset of MS one-third of patients reach a score of 6 on the Expanded Disability Status Scale (EDSS), requiring the use of a unilateral walking aid, and by 30 years the proportion increases to 83%. Within five years of onset the EDSS is six in 50% of those with the progressive form of MS.[46]

A wide range of impairments may exist in MS sufferers which can act either alone or in combination to impact directly on a person's balance, function and mobility. Such impairments include fatigue, weakness, hypertonicity, low exercise tolerance, impaired balance, ataxia and tremor.[47]

Interventions may be aimed at the individual impairments that reduce mobility or at the level of disability. This second level intervention includes provision, education, and instruction in the use of equipment such as walking aids, wheelchairs, motorized scooters and car adaptations as well as instruction on compensatory strategies to accomplish an activity for example undertaking safe transfers by pivoting in a flexed posture rather than standing up and stepping around.

Up to 50% of patients with MS will develop an episode of optic neuritis and 20% of the time optic neuritis is the presenting sign of MS. The presence of demyelinating white matter lesions on brain MRIs at the time of presentation for optic neuritis is the strongest predictor in developing clinical diagnosis of MS. Almost half of the patients with optic neuritis have white matter lesions consistent with multiple sclerosis.

At five year follow-ups the overall risk of developing MS is 30%, with or without MRI lesions. Patients with a normal MRI still develop MS (16%), but at a lower rate compared to those patients with three or more MRI lesions (51%). From the other perspective, however, 44% of patients with any demyelinating lesions on MRI at presentation will not have developed MS ten years later.[48][49]

Individuals experience rapid onset of pain in one eye followed by blurry vision in part or all its visual field. Flashes of light (phosphenes) may also be present.[50]Inflammation of the optic nerve causes loss of vision most usually by the swelling and destruction of the myelin sheath covering the optic nerve.

The blurred vision usually resolves within 10 weeks but individuals are often left with less vivid color vision, especially red, in the affected eye.[citation needed]

A systemic intravenous treatment with corticosteroids may quicken the healing of the optic nerve, prevent complete loss of vision and delay the onset of other symptoms.[citation needed]

Pain is a common symptom in MS. A recent study systematically pooling results from 28 studies (7101 patients) estimates that pain affects 63% of people with MS.[51] These 28 studies described pain in a large range of different people with MS. The authors found no evidence that pain was more common in people with progressive types of MS, in females compared to males, in people with different levels of disability, or in people who had had MS for different periods of time.

Pain can be severe and debilitating, and can have a profound effect on the quality of life and mental health of the sufferer.[52] Certain types of pain are thought to sometimes appear after a lesion to the ascending or descending tracts that control the transmission of painful stimulus, such as the anterolateral system, but many other causes are also possible.[43] The most prevalent types of pain are thought to be headaches (43%), dysesthetic limb pain (26%), back pain (20%), painful spasms (15%), painful Lhermitte's phenomenon (16%) and Trigeminal Neuralgia (3%).[51] These authors did not however find enough data to quantify the prevalence of painful optic neuritis.

Acute pain is mainly due to optic neuritis, trigeminal neuralgia, Lhermitte's sign or dysesthesias.[53]Subacute pain is usually secondary to the disease and can be a consequence of spending too much time in the same position, urinary retention, or infected skin ulcers. Chronic pain is common and harder to treat.[citation needed]

Trigeminal neuralgia (or "tic douloureux") is a disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw, affecting 2-4% of MS patients.[51] The episodes of pain occur paroxysmally (suddenly) and the patients describe it as trigger area on the face, so sensitive that touching or even air currents can bring an episode of pain. Usually it is successfully treated with anticonvulsants such as carbamazepine,[54] or phenytoin[55] although others such as gabapentin[56] can be used.[57] When drugs are not effective, surgery may be recommended. Glycerol rhizotomy (surgical injection of glycerol into a nerve) has been studied[58] although the beneficial effects and risks in MS patients of the procedures that relieve pressure on the nerve are still under discussion.[59][60]

Lhermitte's sign is an electrical sensation that runs down the back and into the limbs and is produced by bending the neck forwards. The sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla, correlating significantly with cervical MRI abnormalities.[61] Between 25 and 40% of MS patients report having Lhermitte's sign during the course of their illness.[62][63][64] It is not always experienced as painful, but about 16% of people with MS will experience painful Lhermitte's sign.[51]

Dysesthesias are disagreeable sensations produced by ordinary stimuli. The abnormal sensations are caused by lesions of the peripheral or central sensory pathways, and are described as painful feelings such as burning, wetness, itching, electric shock or pins and needles. Both Lhermitte's sign and painful dysesthesias usually respond well to treatment with carbamazepine, clonazepam or amitriptyline.[65][66][67] A related symptom is a pleasant, yet unsettling sensation which has no normal explanation (such as sensation of gentle warmth arising from touch by clothing)

Sexual dysfunction (SD) is one of many symptoms affecting persons with a diagnosis of MS. SD in men encompasses both erectile and ejaculatory disorder. The prevalence of SD in men with MS ranges from 75 to 91%.[68] Erectile dysfunction appears to be the most common form of SD documented in MS. SD may be due to alteration of the ejaculatory reflex which can be affected by neurological conditions such as MS.[69] Sexual dysfunction is also prevalent in female MS patients, typically lack of orgasm, probably related to disordered genital sensation.

Spasticity is characterised by increased stiffness and slowness in limb movement, the development of certain postures, an association with weakness of voluntary muscle power, and with involuntary and sometimes painful spasms of limbs.[33] Painful spasms affect about 15% of people with MS overall.[51] A physiotherapist can help to reduce spasticity and avoid the development of contractures with techniques such as passive stretching.[70] There is evidence, albeit limited, of the clinical effectiveness of THC and CBD extracts,[71]baclofen,[72]dantrolene,[73]diazepam,[74] and tizanidine.[75][76][77] In the most complicated cases intrathecal injections of baclofen can be used.[78] There are also palliative measures like castings, splints or customised seatings.[33]

Speech problems include slurred speech, low tone of voice (dysphonia), decreased talking speed, and problems with articulation of sounds (dysarthria). A related problem, since it involves similar anatomical structures, is swallowing difficulties (dysphagia).[79]

Some MS patients develop rapid onset of numbness, weakness, bowel or bladder dysfunction, and/or loss of muscle function, typically in the lower half of the body.[citation needed] This is the result of MS attacking the spinal cord. The symptoms and signs depend upon the nerve cords involved and the extent of the involvement.

Prognosis for complete recovery is generally poor. Recovery from transverse myelitis usually begins between weeks 2 and 12 following onset and may continue for up to 2 years in some patients and as many as 80% of individuals with transverse myelitis are left with lasting disabilities.[citation needed]

Tremor is an unintentional, somewhat rhythmic, muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body. It is the most common of all involuntary movements and can affect the hands, arms, head, face, vocal cords, trunk, and legs. Ataxia is an unsteady and clumsy motion of the limbs or torso due to a failure of the gross coordination of muscle movements. People with ataxia experience a failure of muscle control in their arms and legs, resulting in a lack of balance and coordination or a disturbance of gait.

Tremor and ataxia are frequent in MS and present in 25 to 60% of patients. They can be very disabling and embarrassing, and are difficult to manage.[80] The origin of tremor in MS is difficult to identify but it can be due to a mixture of different factors such as damage to the cerebellar connections, weakness, spasticity, etc.

Many medications have been proposed to treat tremor; however their efficacy is very limited. Medications that have been reported to provide some relief are isoniazid,[81][82][83][84]carbamazepine,[54]propranolol[85][86][87] and gluthetimide[88] but published evidence of effectiveness is limited.[89]Physical therapy is not indicated as a treatment for tremor or ataxia although the use of orthese devices can help. An example is the use of wrist bandages with weights, which can be useful to increase the inertia of movement and therefore reduce tremor.[90] Daily use objects are also adapted so they are easier to grab and use.

If all these measures fail patients are candidates for thalamus surgery. This kind of surgery can be both a thalamotomy or the implantation of a thalamic stimulator. Complications are frequent (30% in thalamotomy and 10% in deep brain stimulation) and include a worsening of ataxia, dysarthria and hemiparesis. Thalamotomy is a more efficacious surgical treatment for intractable MS tremor though the higher incidence of persistent neurological deficits in patients receiving lesional surgery supports the use of deep brain stimulation as the preferred surgical strategy.[91]

MS is a chronic disease that damages the nerves in the spinal cord and brain, as well as the optic nerves. Sclerosis means scarring, and people with MS develop multiple areas of scar tissue in response to the nerve damage. Depending on where the damage occurs, symptoms may include problems with muscle control, balance, vision, or speech.

Nerve damage can cause:

These symptoms may lead to frequent tripping or difficulty walking.

More than half of people with MS experience a vision problem called optic neuritis. This inflammation of the optic nerve may cause blurred vision, loss of color vision, eye pain, or blindness, usually in one eye. The problem is usually temporary and tends to improve within a few weeks. In many cases, vision problems are the first sign of MS.

Although less common than vision problems, some people with MS develop slurred speech. This happens when MS damages the nerves that carry speech signals from the brain. Some people also have trouble swallowing.

MS can take a toll on mental sharpness. Some people may find it takes longer to solve problems. Others may have mild memory loss or trouble concentrating. Most people with MS also experience some loss of bladder control, because signals between the brain and bladder are interrupted. Finally, fatigue is a common problem. You may feel tired even after a good night's sleep.

Confusion, slurred speech, and muscle weakness can be symptoms of MS, but they can also be signs of a stroke. Anyone who suddenly has trouble speaking or moving his or her limbs should be taken to the ER immediately. Treating a stroke within the first few hours provides the best odds of a successful recovery.

In people with MS, the body's own immune system attacks the tissue surrounding the nerve fibers in the brain, spinal cord, and optic nerves. This covering is made of a fatty substance called myelin. It insulates the nerves and helps them send electrical signals that control movement, speech, and other functions. When myelin is destroyed, scar tissue forms, and nerve messages are not transmitted properly.

The roots of MS remain mysterious, but doctors see some surprising trends. It's most common in regions far from the equator, including Scandinavia and other parts of Northern Europe. These areas get less sunlight, so some researchers believe that vitamin D (the "sunshine vitamin") may be involved. Research suggests a possible link between vitamin D deficiency and autoimmune disorders, but studies are ongoing. Genetics appear to play a role, as well.

MS is at least twice as common in women as it is in men. While it can strike people of any race, Caucasians appear to be most at risk. The chances of developing the condition are highest between ages 20 and 50.

Tests are often used, along with a medical history and neurological exam, to diagnose MS and rule out other causes of symptoms. More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis. Lab tests can help rule out other autoimmune conditions or infections such as HIV or Lyme disease.

MS is different in every person. Doctors usually see four forms:

Relapsing-remitting: Symptoms flare during acute attacks, then improve nearly completely or "remit." This is the most common form of MS.

Progressive-relapsing: The underlying disease steadily worsens. The patient has acute relapses, which may or may not remit. This is the least common form of MS.

Research suggests that the disease may be more active during the summer months. Heat and high humidity may also temporarily worsen symptoms. Very cold temperatures and sudden changes in temperature may aggravate symptoms, as well.

While there is no cure for MS, there are "disease-modifying drugs" that can reduce the frequency and severity of MS attacks. Use can result in less damage to the brain and spinal cord over time, slowing the progression of disability. When an attack does occur, high-dose corticosteroids can help cut it short. Many drugs are also available to manage troubling MS symptoms, such as muscle spasms, incontinence, and pain.

About half of people with MS develop some form of pain, either as a result of a short circuit in the nervous system or because of muscle spasms or strain. Doctors may prescribe antidepressants and anticonvulsant medications to ease nerve pain. Pain medicines and anti-spasm drugs may also be used. Muscle pain often responds well to massage and physical therapy. Be sure to discuss the options with your doctor if you find yourself in pain.

If MS affects balance, coordination, or muscle strength, you can learn to compensate. Physical therapy can help strengthen muscles, combat stiffness, and get around more easily. Occupational therapy can help retain coordination in your hands for dressing and writing. And if you're having trouble speaking or swallowing, a speech therapist can help.

Many nontraditional therapies for MS have not been well studied. Some people say acupuncture relieves symptoms such as muscle spasms and pain, but research to confirm its value isn't conclusive. Others have reported benefits from injections of bee venom, but a rigorous study, lasting 24 weeks, showed no improvements in disability, fatigue, or the number of MS attacks. It's important to inform your doctor about any supplements, special diets, or other therapies you want to try.

Doctors generally agree that its safe for women with MS to get pregnant. Research suggests no increased risk of complications during pregnancy. In fact, many women have fewer MS symptoms during pregnancy. High levels of hormones and proteins may suppress the immune system, reducing the odds of a new attack. It's best to talk with your doctors before pregnancy, as certain MS drugs should not be used while pregnant or nursing.In the early months after delivery, the odds for a relapse can rise.

The vast majority of people with MS are able to continue walking, though many benefit from some type of assistive device. Orthotic shoe inserts or leg braces can help increase stability. When one leg is stronger than the other, a cane can help. People with significant problems with their legs may need to use a walker. And a wheelchair or scooter may be best for those who are very unsteady or tire easily.

Making a few changes around the home can help you manage daily activities on your own. Install grab bars inside and outside the shower or tub. Use a non-slip mat. Add an elevated seat and safety rails to the toilet. Lower one of your kitchen counters so you can reach it from a sitting position. And get rid of any throw rugs, which are a tripping hazard.

Exercise can ease stiffness, fatigue, and other symptoms of MS. But overdoing it could make things worse. It's best to start slowly. Try exercising for 10 minutes at a time, then gradually working your way up to a longer session. Before you begin, check with your doctor about what type of activity and level of intensity would be most appropriate. A few possibilities include water aerobics, swimming, tai chi, and yoga.

Most people with MS live a normal or near-normal lifespan. While the condition may make it more difficult to get around or complete certain tasks, it doesn't always lead to severe disability. Thanks to effective medications, rehab therapies, and assistive devices, many people with MS remain active, stay in their jobs, and continue to enjoy their families and favorite activities.

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS. They can include

No one knows what causes MS. It may be an autoimmune disease, which happens when your immune system attacks healthy cells in your body by mistake. Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Usually, the disease is mild, but some people lose the ability to write, speak, or walk.

There is no single test for MS. Doctors use a medical history, physical exam, neurological exam, MRI, and other tests to diagnose it. There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.

A major genetic study Tuesday confirmed a link between low vitamin D and a higher risk of multiple sclerosis, a finding which experts say could lead to better treatment and prevention.

Previous observational studies have found an association between a person's level of vitamin D, which comes from sunlight and from certain foods, and MS, a debilitating autoimmune disease that affects nerves in the brain and spinal cord, and has no known cause or cure.

But the problem with these studies was that they could not prove that low vitamin D caused MS, and may indeed have been showing simply that people who were sick tended to stay inside more and get less sunlight.

The latest study by Brent Richards, from McGill University, Canada, and colleagues published this week in PLOS Medicine, gets around that obstacle by analyzing the association between genetically reduced vitamin D levels and the likelihood of MS in a pool of 14,498 people with multiple sclerosis and 24,091 healthy controls.

The study found that people with genetically lower vitamin D levels face double the risk of getting MS, which is often diagnosed between age 20 and 50.

"The results show that if a baby is born with genes associated with vitamin D deficiency they are twice as likely as other babies to develop MS as an adult," explained Benjamin Jacobs, director of Children's Service at the Royal National Orthopedic Hospital in London.

Jacobs, who was not involved in the study, described its findings as "important."

"This could be because vitamin D deficiency causes MS or possibly because there are other complex genetic interactions," he said.

"We do not yet know if giving healthy children and adults vitamin D will decrease their risk of developing MS, but clinical trials are being conducted now to study this."

MS is a chronic disease that affects some 2.3 million people worldwide, causing blurred vision, slurred speech, tremors, extreme fatigue, problems with memory, paralysis and blindness.

You probably know your nerves carry messages around your body. So if you stub your toe, your nerves deliver the message to your brain that says "Ouch!" Nerves also send signals that tell your muscles what to do when you want to walk and run.

In someone who has multiple sclerosis (MS), there are roadblocks in the pathways so the messages don't get to the brain like they should.

That leads to problems like:

MS is mostly a disease that adults get and is usually diagnosed between the ages of 20 and 50. It is more common in women than men.

If you know someone who has MS, you probably want to know what the disease will be like for them. The disease does tend to get slowly worse over time, but most people with MS have mild symptoms and live to be as old as people without MS.

Let's talk about what's causing those roadblocks for the signals. If a person has MS, the immune system which usually fights germs attacks nerves in the brain and spinal cord. It damages the layer of tissue, called myelin, which surrounds and protects the nerves.

When myelin becomes damaged, scars develop. The word sclerosis comes from the Greek word for scarring or hardening. And those scars can act like stones in the road, creating a bumpy ride for signals as they travel between the brain and body.

When those signals get slowed down or blocked, people with MS feel one or more symptoms, such as vision problems or feeling unsteady on their feet. The symptoms will vary depending on what nerves are affected.

There are four different categories of MS:

MS is rare in kids. About 5% of cases of MS are diagnosed in children. MS in kids tends to progress more slowly than MS diagnosed in adults.

Nobody knows exactly why a person gets multiple sclerosis. It is not contagious, so you can't catch it from someone who has it. And it's not hereditary. That means the disease is not passed on directly from one generation to the next, like eye color.

But your chances of developing MS are greater if a close relative, such as a parent or sibling, has it. Scientists are still studying why.

When people begin to experience what could be early signs of MS, such as vision or balance problems, doctors will take a careful history and do a complete physical exam. Since there is no one test that can determine if a person has MS, the doctor may order several tests, including blood tests, cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) tests, and brain scans.

A brain MRI, or magnetic resonance imaging test, lets a doctor check for evidence of scars in the brain and spinal cord by taking detailed pictures of these body areas.

Another frequent stop on the way to an MS diagnosis is a series of evoked potentials (EP) tests, which test the time it takes for nerves to respond. If the response time is slow, the chances are greater that there's damage along the nerve pathways.

Currently, there is no known cure for multiple sclerosis, but medicines can help control symptoms. When a flare-up or relapse happens, steroids lessen inflammation and help speed up recovery. Several medicines can be given to reduce the number of relapses and slow down progression of the disease.

People with MS can take steps to manage symptoms, including physical and occupational therapy. Eating a balanced diet and exercising regularly are also important when it comes to overall health and well-being for people living with MS.

If someone you love has MS, you can be supportive in lots of ways. The person might appreciate some help with stuff like opening doors. If you live with this person, it's great to be quiet when he or she is resting.

As you get older, you might be able to help with other stuff, like getting groceries or doing other stuff around the house. But most of all, the person will like knowing that you're understanding and ready to help.

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All About Multiple Sclerosis aims to provide accurate and comprehensive medical information about multiple sclerosis (MS) written in plain English by people living with the disease and its symptoms. It contains a detailed description of multiple sclerosis, a large archive of news stories about MS, an MS encyclopedia and a large links section containing hundreds of commented and rated links. It also has a list of famous people with multiple sclerosis and personal accounts, poems and essays by people with MS. The site receives no sponsorship from pharmaceutical or other financially interested companies and maintains absolute editorial independence.

Every effort is made to ensure that the information is medically up-to-date and accurate.

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You can email me at jones.paul@btconnect.com. I cannot answer personal health queries - you should discuss these with your GP or neurologist. General health information and support is available from most national MS Societies. Here are details of some MS Society free telephone numbers:

Multiple sclerosis symptoms vary widely, and a description of "typical" symptoms is difficult. All the symptoms involve changes in neurologic functioning, but there are striking differences among patients in the type, severity, and frequency of these symptoms. Different disease patterns such as relapsing-remitting (RR), primary-progressive (PP), secondary-progressive (SP), and progressive-relapsing (PR) classify the condition according to the development and progression of symptoms over time. Relapsing-remitting (RR) multiple sclerosis is the most common type, in which symptoms (exacerbations of the condition) are followed by periods of time with reduced or no symptoms. These relatively symptom-free periods, known as remissions, can last for days or for many years.

Some cases of multiple sclerosis are so mild that the condition is difficult to diagnose. In other cases, there is a gradual decline in functioning through the years. In very rare cases, symptoms can be so severe and rapidly progressing as to be fatal within a short time (known as malignant or fulminant MS). Symptoms can be related to one body part or may involve multiple areas of the body. They may be of short duration or may persist for a long time. Some symptoms of multiple sclerosis are mild and cause inconvenience; others may be severe and debilitating.

Visual disturbances can be the first sign of MS. The vision changes can include blurred vision, distortions, or loss of vision in one eye. The vision symptoms can be accompanied by eye pain. Other symptoms can include tingling, numbness, prickling pain, or muscle spasms in the arms and legs that may occur at one or multiple sites. Weakness in the arm and leg muscles may occur, and this can sometimes affect balance and posture, causing clumsiness or lack of coordination. Other symptoms include fatigue, dizziness, difficulties with speech, tremors, heat intolerance, and loss of sensation. Sexual dysfunction and loss of bladder or bowel control can develop in more serious cases.

Mental changes can also occur as symptoms of multiple sclerosis. Memory loss, decreased ability to concentrate, attention deficits, an inability to perform sequential tasks, and changes in judgment have all been reported. Depression, mania, paranoia, and uncontrollable urges to laugh or weep are other symptoms that have been described.

Summary of Common MS Symptoms by MedicineNet Staff A review of our Patient Comments indicated that many people with multiple sclerosis (MS) have similar symptoms. Many patients said that they were in their 40s when their symptoms began. Optic neuritis was often the first MS symptom that people experienced. Initial symptoms also included numbness in the arms, feet, hands, and face, coupled with fatigue, dizziness, and difficulty walking. Several people also reported losing their balance and falling down, while others mentioned feeling a prickly heat sensation in their legs. Read on to learn more about MS symptoms in our Patient Comments.

The symptoms of multiple sclerosis are very variable and differ from patient to patient. They can also be confused with symptoms of many other conditions. A physician should be notified if you or someone you know has any of the signs and symptoms associated with multiple sclerosis. Also check with a doctor if you or someone you know has any signs or symptoms that may not be associated but that are of concern. The person may not have multiple sclerosis, but because of the nonspecific nature of this disease, it is best to let a qualified professional make that determination.

Several of the symptoms of multiple sclerosis may be severe enough to send the patient to a hospital's emergency department.

Diagnosing multiple sclerosis is difficult. The vague and nonspecific nature of this disease mimics many other diseases. Doctors combine history, physical exam, laboratory work, and sophisticated medical imaging techniques to arrive at a diagnosis.

Multiple sclerosis(MS) is a disease with unpredictable symptoms that can vary in intensity. While some people experience fatigue and numbness, severe cases of MS can cause paralysis, visionloss, and diminishedbrainfunction.

MS affects an estimated 2.3 million people worldwide. Womenare affected more than twice as often as men, according to the National MS Society. Family history is also a major risk factor.

MS is a progressive autoimmune disorder. That means the system designed to keep your body healthy mistakenly attacks parts of your body that are vital to everyday function. The protective covering of nerve cells are damaged, which leads to diminished function in the brain and spinal column.

The cause of MS largely remains a mystery, even though the disease was discovered in 1868. Researchers know the nerve damage is caused by inflammation, but the cause of the inflammation is still unknown.

The most common early signs of MS arevision problems, clinically called optic neuritis. Inflammation affects the optic nerve and disrupts central vision. This can lead toblurred visionin one or both eyes, double vision, or loss of contrast or vivid colors.

You may not notice the vision problems immediately, as degeneration of clear vision can be slow. Pain when you look up or to one side also can accompany vision loss.

MS affects nerves in the brain and spinal column (the bodys message center). This means it can send conflicting signals around the body. Sometimes, no signals are sent. This results in the most common symptom:numbness.

Tingling sensations and numbness are the most common warning signs of MS. Common sites of numbness include the face, arms, legs, and fingers.

Chronic pain and involuntary muscle spasms are also common with MS. One study, according to the National MS Society, showed that half of people with MS had either clinically significant pain or chronic pain.

Muscle stiffness or spasms (spasticity) are also common. They involve feelings of stiff muscles or joints as well as uncontrollable, painful jerking movements of extremities. The legs are most often affected, but back pain is also common.

Unexplainedfatigueand weaknessaffect about 80 percent of people in the early stages of MS.

Chronic fatigue occurs when nerves deteriorate in the spinal column. Usually, the fatigue appears suddenly and lasts for weeks before improving. The weakness is most noticeable in the legs at first.

Dizzinessand problems with coordination and balance can decrease the mobility of someone with MS. Your doctor may refer to these as problems with yourgait.People with MS often feel lightheaded, dizzy, or feel as if their surroundings are spinning (vertigo). This symptom often occurs when a person stands up.

Adysfunctional bladderis another symptom occurring in up to 80 percent of people with MS. This can include urinating frequently, strong urges to urinate, or inability to hold in urine.

Urinary-related symptoms are often manageable. Less often, people with MS experience constipation, diarrhea, or loss of bowel control.

Sexual arousalcan also be a problem for people with MS because it begins in the central nervous system where MS attacks.

About half of people with MS will develop some kind of issue with their cognitive function. This can include:

Depression and other emotional health problems are also common.

Major depressionis common among people with MS. The stresses of MS can also cause irritability, mood swings, and a condition calledpseudobulbar affect: bouts of uncontrollable crying and laughing.

Coping with MS symptoms, along with relationship or family issues, can make depression and other emotional disorders even more challenging.

Not everyone with MS will have the same symptoms. Different symptoms can manifest themselves during attacks. Along with the symptoms mentioned on the previous slides, MS can also cause:

MS often astounds doctors because of how much it can vary in both its severity and the ways that it affects people. Attacks can last a few weeks and then disappear. However, relapses can get progressively worse, more unpredictable, and come with different symptoms.

However, early detection may help prevent MS from progressing quickly.

MS isnt necessarily hereditary. However, you have a higher chance of developing the disease if you have a close relative with MS, according to theNational MS Society.

The general population only has a tenth of a percent chance of developing MS. But theNational MS Societyreports that number jumps to 2.5 to 5 percent if you have a sibling or parent with MS.

Heredity isnt the only factor in determining MS. An identical twin only has a 25 percent chance of developing MS if their twin has the disease. While genetics is certainly a risk factor, its not the only one.

A doctor most likely a neurologist will perform several tests to diagnose MS, including:

Doctors use these tests to look for damage to the central nervous system in two separate areas that occurred at least one month apart. These tests are also used to rule out other conditions.

MS is a challenging disorder, but researchers have discovered many treatments that can slow its progression.

The best defense against MS is seeing your doctor immediately after you experience the first warning signs. This is especially important if someone in your immediate family has the disorder, as its one of the key risk factors for MS.

Multiple sclerosis (MS) is an inflammatory, chronic, degenerative disorder that affects nerves in the brain and spinal cord. Myelin, the fatty substance that surrounds and insulates nerves and facilitates the conduction of nerve impulses is the initial target of inflammatory destruction in multiple sclerosis.

MS is characterized by intermittent damage to myelin, called demyelination. Demyelination causes scarring and hardening (sclerosis) of nerve tissue in the spinal cord, brain and optic nerves. Demyelination slows conduction of nerve impulses, which results in weakness, numbness, pain and vision loss.

Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body. Early symptoms of the disorder may include vision changes (e.g., blurred vision, blind spots), numbness, dizziness and muscle weakness.

MS can progress steadily or cause acute attacks (exacerbations) followed by partial or complete reduction in symptoms (remission). Most patients with the disease have a normal lifespan.

MS is the most common neurological cause of debilitation in young people. According to the National Institute of Neurological Disorders and Stroke, about 250,000 - 350,000 people in the United States have been diagnosed with multiple sclerosis. Worldwide, the incidence of MS is approximately 0.1 percent. Northern Europe, the northern United States, southern Australia, and New Zealand have the highest prevalence, with more than 30 cases per 100,000 people.

MS is more common in women and in Caucasians. The average age of onset is between 20 and 40, but the disorder may develop at any age. Children of parents with MS have a higher rate of incidence (30 - 50 percent).

Multiple sclerosis is an autoimmune disease that affects the nervous system. Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. In people who have MS, the immune system destroys the substance that surrounds and protects your nerve cells the myelin sheath.

The job of the nervous system is to send electrical messages back and forth from the brain to different parts of the body. Normally, the brain quickly sends signals through the spinal cord and then through nerves that branch out to all organs and body parts. When myelin around nerves is damaged or destroyed, the nerves cant function properly to deliver these signals in the right way. This can cause symptoms throughout the body.

The most common form of MS is known as relapsing-remitting MS (RRMS). When people who have this kind of MS have flare-ups, the symptoms become noticeably worse. Then there is a period of recovery, when symptoms get better or disappear completely for some time. In RRMS, symptom flare-ups may be triggered by an infection, such as the flu. More than 50% of people who have RRMS develop the secondary progressive type in which there are relapses followed by a gradual worsening of the disease.

About 15% to 20% of people who have MS have a form known as primary-progressive MS (PPMS). In this kind of MS, the disease gets steadily worse, without any remissions. A fourth typeprogressive relapsing MSis rare, but the pattern follows a worsening of the disease with sudden, clear relapses.

Often MS is mild, but some people lose the ability to write, speak or walk.

This information was developed as part of an educational program made possible through support from AstraZeneca.

Multiple sclerosis is an autoimmune disorder in which the bodys immune system attacks the protective sheath (myelin) that insulates your nerves and helps mediate the transmission of nerve impulses. As a result, the electrical impulses that travel along the nerves decelerates, which slows down the communication between your brain and rest of the body. Furthermore, nerve damage also occurs. Symptoms of multiple sclerosis may vary with the extent of nerve damage and the type of nerves affected.

As multiple sclerosis progresses, a person may begin to lose the ability to see, walk, write or speak. According to the National Multiple Sclerosis Society, multiple sclerosis is the leading cause (with the exception of physical trauma) of neurological disability beginning in early to mid-adulthood (most people are diagnosed between the ages of 20 and 50), with 200 people being diagnosed with multiple sclerosis every week.

Overall, multiple sclerosis affects an estimated 400,000 Americans and is significantly more common amongst women. Currently there is no cure for multiple sclerosis. However, treatments can help treat attacks, modify the course of the disease and treat symptoms.

Symptoms of multiple sclerosis vary between individuals and can change as the disease progresses. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions). Multiple sclerosis symptoms include:

The exact cause of multiple sclerosis is currently unknown. It is generally accepted that multiple sclerosis is an autoimmune disorder. Scientists believe that a host of factors may contribute to the onset of multiple sclerosis including, exposure to environmental toxins, genetics, and childhood exposure to certain viruses or bacteria.

The following factors may increase your risk of developing multiple sclerosis:

In order to make a diagnosis of multiple sclerosis, your doctor must definitively conclude all of the following:

There is currently no cure for multiple sclerosis. Treatment regimens typically focus on managing symptoms and attacks of multiple sclerosis.

Multiple sclerosis(MS),also called disseminated sclerosis, a progressive disease of the central nervous system characterized by the destruction of the myelin sheath surrounding the nerve fibres of the brain, spinal cord, and optic nerves. As a result, the transmission of nerve impulses becomes impaired, particularly in pathways involved with vision, sensation, and movement.

MS has a worldwide distribution but is five times more common in temperate regions than in tropical regions. The disease primarily occurs in individuals between the ages of 20 and 40, and women are affected by the disease more often than men.

There are four major types of MS: relapsing-remitting (RRMS), secondary-progressive (SPMS), primary-progressive (PPMS), and progressive-relapsing (PRMS). About 8085 percent of patients are diagnosed initially with RRMS. In this form of the disease, onset is usually gradual, and there are alternating intervals of symptom exacerbation and complete symptom remission. In many patients with RRMS, symptoms may worsen gradually during subsequent recurrences and eventually may no longer disappear during remissions. When this occurs, the patients diagnosis changes from RRMS to SPMS. About 1015 percent of patients have PPMS, which is characterized by steady disease progression from the time of onset, without relapse-remission cycles. PRMS is a rare form of the disease, occurring in less than 5 percent of MS patients. This type is distinguished from other forms of MS by its steady worsening of symptoms from the time of onset, in which intermittent flare-ups become increasingly severe. There are no periods of complete symptom remission in PRMS.

In most forms of the disease, initial symptoms include numbness or tingling in the extremities or on the side of the face, muscle weakness, dizziness, unsteady gait, and visual disturbances such as blurred or double vision and partial blindness. The intensity of these early symptoms subsides in most individuals for months or even years. But in progressive forms of MS, remissions usually become shorter as the disease advances. New signs and symptoms may appear, including abnormal reflexes, difficulty in coordinating and controlling movement, bladder dysfunction, and neuropsychological problems such as depression, memory loss, and emotional instability. Eventually the impairment of motor control can develop into complete paralysis. Despite disease progression, most people with MS have a normal life expectancy.

The cause of MS remains unclear, but in many cases there is evidence of a genetic component. In fact, nearly five dozen different genetic variations have been associated with increased risk for the disease. Variations occurring in a cluster of genes that make up the major histocompatibility complex (MHC; also called human leukocyte antigen, or HLA, system), which regulates immune function, appear to have the most significant effect on risk. Some of these variations appear to be associated with environmental factors that precipitate the onset of disease. For example, the risk of MS in northern Europeans who carry a particular MHC variant is exacerbated by vitamin D deficiency, which weakens immune function.

Vitamin D deficiency as a factor in the development of MS has been further implicated by the identification of rare loss-of-function variations in a gene known as CYP27B1 that result in reduced vitamin D levels in the body. The inheritance of one copy (from one parent) of the mutated gene is sufficient to produce MS (inheritance of two copies, one from each parent, causes vitamin D-dependent rickets I, or pseudo-vitamin D-deficiency rickets). Thus, in those people who carry variations associated with or intensified by vitamin D deficiency, vitamin D supplementation may confer some degree of protection against MS.

There are also variations in other genes that have been identified and associated with MS, including several occurring in genes that encode proteins for signaling molecules known as interleukin receptors. These receptors are expressed on the cell membranes of B and T lymphocytes and play an important role in regulating lymphocyte development. Some variations in interleukin receptor genes are associated with autoimmune diseases, such as type 1 diabetes and Graves disease. There is much evidence suggesting that MS results from an autoimmune reaction in which a malfunctioning immune system produces T cells that react with and damage the bodys own cells, specifically the myelin sheath of nerve fibres. The trigger for this autoimmune reaction is not known, but it is suspected to be related to genetic factors, with the interaction of variations in multiple genes, rather than a single gene, being a likely cause. Some scientists believe these changes in immune function could also be the result of exposure to a virus.

There is no cure for MS, but a number of medications, such as corticosteroids, are used to alleviate symptoms. In addition, there are a handful of disease-modifying agents available for MS. These agents can reduce the frequency of relapses and generally slow the progress of the disease. Immunotherapy with different forms of interferon beta, a protein the body normally produces to modulate immune response, is used to reduce the severity and frequency of the exacerbation periods of the disease. Natalizumab (Tysabri), a monoclonal antibody (an antibody clone derived from a single immune cell), is also effective for controlling the severity and frequency of relapses. Natalizumab attaches to molecules on the cell membrane of lymphocytes, preventing them from entering the central nervous system and attacking nerve cells. Another monoclonal antibody, called Alemtuzumab (Campath), which is used to treat chronic lymphocytic leukemia, also binds to the cell membrane of lymphocytes but works by stimulating antibody-mediated destruction of the cells. In clinical trials in patients with early-stage RRMS, this agent not only stopped progression of the disease but also facilitated the restoration of nerve function in some patients. Other disease-modifying agents used to treat MS include glatiramer acetate (Copaxone) and the immunosuppressant drug mitoxantrone (Novantrone).

Another treatment for MS that has been explored in clinical trials is a form of stem cell therapy called autologous (self) hematopoietic stem cell transplant. This therapy has been tested only in patients who have not responded to conventional treatment regimens and therefore elect to undergo immunosuppressive therapy to destroy lymphocytes that have acquired autoimmune characteristics. Prior to the administration of immunosuppressive drugs, hematopoietic stem cells are harvested from the patients blood or bone marrow. These cells are then frozen and stored for later reinfusion into the patient following immunosuppressive therapy. Because hematopoietic stem cells have the potential to develop into normally functioning lymphocytes, transplant provides the patients immune system with an opportunity to recover normal activity. This treatment has proved successful in stopping or delaying disease progression in some patients, and, in rare cases, it has even led to the repair of neurological damage. However, significant risks are associated with stem cell therapy, including increased susceptibility to infection and possibility of transplant failure or relapse of disease.

Multiple sclerosis (MS) is an unpredictable disease of the nervous system that disrupts communication between the brain and other parts of the body. Its effects can range from relatively mild in most cases to somewhat disabling to devastating. The symptoms may mysteriously occur and then disappear. In the worst cases, a person with MS may be unable to:

During an MS "flare", inflammation occurs in areas of the white matter (pale colored nerve tissue) of the central nervous system in random patches called plaques. This is followed by destruction of myelin, the fatty covering that protects nerve cell fibers in the brain and spinal cord. Myelin allows for the smooth, high-speed transmission of electrochemical messages between the brain, the spinal cord, and the rest of the body. When myelin is damaged, it may block or slow neurological transmission of messages, resulting in diminished or lost function.

Symptoms of MS include:

The cause of MS is unknown. Scientists think the disease isan autoimmune condition influenced by genetic and environmental factors. Other theories include a childhood virus that primes the immune system for an attack against myelin in early adulthood.

People with the following conditions or characteristics are at risk for developing MS:

If you have symptoms associated with MS, you should see your health care provider. Your provider will:

The primary goal of treatment is to reduce the severity of attacks using certain medications and to extend the individual's physical functioning for as long as possible.

Your health care provider may prescribe the following medications, (or a combination of the following medications):

Surgery may help treat severe and disabling tremors and reduce severe spasms.

A comprehensive treatment plan for MS may include a range of complementary and alternative medical therapies (CAM). Always work with a knowledgeable provider when seeking CAM therapies for the treatment of MS. Some CAM therapies may interfere with conventional treatments. Inform all of your providers about any CAM therapies you are considering.

These nutritional tips may help reduce symptoms:

You may address nutritional deficiencies with the following supplements:

Herbs are one way to strengthen and tone the body's systems. As with any therapy, you should speak with your provider before starting treatment. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually. Combination remedies may be used for fatigue, spasm, and to help rid the body of impurities. Remedies include:

About 70% of people experience attacks and remissions, and about half of these undergo a chronic, progressive worsening after about 10 years. 10 to 15% of people experience a chronic, progressive, worsening of the disease from the initial onset, and 15 to 20% of people have a relatively mild course of the disease. Most people with MS live for 30 years or more with the disease, many still working and mobile, though bladder, bowel and sexual dysfunction are common among this population. People who have MS are at a higher risk than the general population of:

MS is also associated with increased risk of some cancers, including urinary organs and brain tumors.

People with MS will need lifelong monitoring, especially during flare-ups.

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Multiple sclerosis (MS) is a disease that affects the . It causes and the destruction of . Myelin surrounds nerve fibers and acts like insulation on a wire, preventing "short-circuits" that divert a nerve signal from having its desired effects. The "demyelination" process interferes with nerve impulse transmission, affects muscular control, and causes a variety of sensory, motor, and psychological symptoms. Damage to the myelin usually resolves with time and symptoms subside, but repeated attacks can lead to a continual process of demyelination and remyelination, which produces nerve fiber scarring and progressive disability.

The cause of MS is unknown. It is thought to be an autoimmune process triggered by a , environmental factors, and/or a genetic predisposition. Typically, MS first appears and is diagnosed when individuals are between 20 and 50 years of age, although it can occur in young children. It affects women more frequently than men, is more common in Northern European Caucasians than other ethnic groups, and is seen in greater numbers in people who live in temperate climates than warm ones. According to the National Multiple Sclerosis Society, MS affects about 2.1 million people worldwide. It is estimated that about 250,000 to 350,000 people in the U.S. have MS, according to the National Institute on Neurological Disorders and Stroke. The risk of developing this disease is estimated to be about 1 in 750 in the general population. In families with an affected member, the risk rises to 1 in 40, and it is about 1 in 4 for the identical twin of an affected person, strengthening the notion of a genetic component to the cause.

There is no single test that can conclusively diagnose MS. Instead, health practitioners look for a combination of factors to determine if a patient has MS. The factors are described in a document called the "McDonald Criteria," named for the doctor who chaired the 2001 panel of experts charged with establisheding criteria for an accurate diagnosis. The document is updated regularly as new research improves our understanding of the disease. Physicians will consult a patient's medical history and a variety of clinical and laboratory tests to aid in their diagnosis. In applying the criteria for diagnosing MS, a health practitioner must:

Once diagnosed, an individual may be classified as having one of several types of MS, based on signs and symptoms, frequency of relapses, rate of disease progression, and the number of areas that are damaged in the CNS:

Because MS can attack any area of the , the and of MS are many and varied. They are associated with what the nerves in the affected area(s) are responsible for controlling. Symptoms of MS may come and go, and their duration may last from days to months. Some of these include:

According to the National Multiple Sclerosis Society, about 85% of those with multiple sclerosis initially have relapsing-remitting MS. They experience periodic attacks or relapses followed by healing and symptom remission. Later in the course of the disease, about half develop secondary-progressive MS. Their symptoms and disabilities worsen as they continue to have relapses but do not fully recover. About 10% of people with MS have a progressive form of the disease. They grow gradually worse without experiencing remissions.

Although there is no single test or set of tests that can establish a diagnosis of multiple sclerosis (MS), there are three tests that are generally considered useful:

Laboratory tests There are no laboratory tests that are completely specific for multiple sclerosis, but several laboratory tests are helpful in diagnosing or excluding this disease as the cause of a person's signs and symptoms. The most useful tests look for evidence of production within the central nervous system.

An elevated IgG index indicates increased production of IgG within the central nervous system. It is found in about 90% of MS cases.

Health practitioners may also test for diseases that can cause symptoms similar to MS to determine if they may be responsible for a patient's illness. Examples include:

Non-laboratory tests

In addition to the standard MRI, there are a variety of specialized techniques that may be performed, such as functional MRI, magnetic resonance spectroscopy, and diffusion-tensor MRI. The National Multiple Sclerosis Society (NMSS) web site has more information on the use of MRI in MS.

Two other types of evoked potentials may be used, though less commonly. Brain stem auditory evoked potentials (BAEP) is a test that helps detect lesions in the brainstem causing delays in the transmission of sounds. Somatosensory evoked potentials (SSEP) is a test that applies a brief electrical stimulus to the wrist or ankle. It detects disruptions in the pathways from the arms and legs to the brain at very specific points of the central nervous system.

There is no cure for multiple sclerosis, but a variety of treatments are available that can reduce the frequency and severity of relapses.

The goals of MS treatment are to slow the progression of the disease, relieve symptoms, and minimize the effects of acute attacks. Health practitioners may prescribe corticosteroids for short periods of time to help reduce the severity of relapses as well as other medications to address specific symptoms, such as beta interferon, copolymer I, natalizumab and fingolimod, the first oral therapy approved by the U.S. Food and Drug Administration for treatment and management of MS symptoms. Fatigue and depression sometimes associated with MS may be treated with appropriate antidepressants or steroidal drugs. For more on specific medications that may be prescribed, see the Treatments page on the National MS Society web site.

MS does not significantly decrease the lifespan of those who have it, but it can frequently and intermittently affect quality of life. People with MS usually work with a team of professionals who help support and monitor their condition and address their changing needs. Current MS research is directed toward understanding the cause of MS in hopes of developing better drugs to treat, if not cure or prevent the disease.

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Multiple sclerosis is a progressive autoimmune disease and the most common neurological disease diagnosed in young adults. Multiple sclerosis commonly called MS, attacks the central nervous system and can cause significant nerve damage. The progression and severity of the disease varies greatly between individuals and it can result in a wide variety of effects, from mild to severe and disabling. These include muscle weakness, loss of balance, inability to walk, and paralysis.

The causes of multiple sclerosis are not well understood. Researchers believe that the body's immune system begins to attack its own nervous system, specifically the myelin, a fatty material that covers and insulates the nerve cells in the central nervous system. Healthy myelin is vital to the normal, rapid movement of electrical impulses through the nerve pathways.

In multiple sclerosis, patches of myelin in the brain and spinal cord become inflamed, swell, and develop lesions. Myelin and nerve cells become damaged, which wreck havoc with the normal transmission of electrical impulses.

It is believed that this process may be triggered by a combination of genetic factors and environmental elements, such as exposure to a virus or some infections.

Symptoms of multiple sclerosis can vary greatly between individuals. In the early stages of the disease, symptoms come and go, and people with multiple sclerosis can experience periods of remission, in which symptoms disappear and periods of relapse, in which symptoms reappear. Symptoms may worsen during relapses and complications can include seizures, changes in mentation, muscle spasms, and depression.

Symptoms generally first appear between the ages of 20 and 40 years. Most often, the first symptom is visual changes. Other symptoms may include dizziness, muscle weakness, incoordination, balance problems, fatigue, trembling, abnormal sensations in the extremities, and cognitive impairment, and paralysis. For more information on symptoms, refer to symptoms of multiple sclerosis.

Testing for multiple sclerosis is an involved process because there is no single test that will specifically diagnose the condition. In addition, a definitive diagnosis of multiple sclerosis may often be delayed because early symptoms are often mild, vague, disappear for periods of time, and/or may mimic other conditions. Multiple tests are needed to rule out other conditions that can be confused with multiple sclerosis or that have similar symptoms affecting the nervous system. These include some viral infections, lupus, lime disease, and vitamin deficiencies. For more information on misdiagnosis, refer to misdiagnosis of multiple sclerosis.

A diagnosis of multiple sclerosis is generally made by a neurologist and is made based on the compilation of a thorough neurological history and physical, blood tests, a lumbar puncture, and an MRI, which may show the brain and spinal cord damage and lesions characteristic of multiple sclerosis.

There is no cure for multiple sclerosis, but the disease can be managed and symptoms controlled to various degrees of success with a variety of medications, such as interferons, copolymer, novantrone, natalizumab, corticosteroids, and muscle relaxers. Other therapies include physical therapy, avoiding heat, regular exercise, eating a healthy well-balanced diet and maintaining an optimal weight. Equipment, such as walkers, canes, and braces may also be needed to help maintain independence. For more information on treatment, refer to treatment of multiple sclerosis. ...more

Multiple Sclerosis: Multiple sclerosis is a nerve or spinal cord disease that causes random damage to parts of the nervous system. The result is a diverse range of possible symptoms depending on which parts of the cord are damaged, and how often the inflammation reoccurs. Typical symptoms are any kind of tingling, numbness, burning sensations, "pins-and-needles" or other types of sensory changes in various parts of the body; also possible are vision changes (see a full list of symptoms).

Prognosis of multiple sclerosis is highly variable. Some people have very minor problems, whereas others can end up in a wheelchair, lose vision, or other nasty complications. It just depends which part of the spinal cord or nervous system is attacked. Some people have what is called a "single sclerosis" where there is only one incident of a sclerosis (lesion) on the spinal cord, and this may or may not progress to "multiple" sclerosis.

The cause of multiple sclerosis is an autoimmune disease, which means that the immune system is somehow triggered to mount an attack against its own good cells - in this case the cells that surround nerves. ...more